الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
Abstract
Obesity became an epidemic disease. Physical, psychological, and economic complications are associated with obesity which leads to difficulty in caring of obese patients by physicians globally. Obesity is diagnosed by body mass index (BMI).
Obesity is associated with raised cardiovascular risk factors such as hypertension, type 2 diabetes mellitus and dyslipidemia. Abnormalities of lipid profile associated with obesity include increased serum level of total cholesterol, low-density lipoprotein (LDL) cholesterol, very low-density lipoprotein (VLDL) cholesterol, triglycerides, and a reduction in serum high-density lipoprotein (HDL) cholesterol.
The treatment of choice for obesity depends upon the type of obesity and the clinical features of each patient, but generally begins with modification of the diet, health education, and medication.
Bariatric surgery is the most effective treatment for severe obesity. This surgical procedure causes persistent weight loss and increases quality of life and eventually patients’ life expectancy. Furthermore, bariatric surgery can lead to improved glucose metabolism and lowered cardiovascular risk. Surgical procedures for the treatment of obesity can be divided into three general categories: malabsorptive procedures, restrictive procedures and combined malabsorptive/ restrictive procedure. The procedures have shown significant beneficial effects beyond weight reduction, including resolution of dyslipidemia.
sleeve gastrectomy (SG) a technique that reduces nutrient absorption, is one of the most popular procedures in the world. SG is a technically less complex procedure with short learning curve and effective weight loss, but it suffers from two outstanding disadvantages including high risk of weight regain and gastro- esophageal reflux disease (GERD).
Mini-gastric bypass (MGB), which restricts nutrient absorption, also known as single anastomosis gastric bypass or omega gastric bypass, is a newly emerged procedure. Due to safe and simple process as well as effective outcomes, MGB has quickly become one of the most popular procedures in many countries.
These techniques are associated with a 15–30% total weight loss (TWL), improved weight control and a better lipid profile. Indeed, even a 5–10% weight loss can lead to improved lipid metabolism, increasing the HDL cholesterol concentration and lowering those of triglycerides, total cholesterol and LDL cholesterol. The study is aimed to evaluate the effect of two types of bariatric surgery; mini-gastric bypass and sleeve gastrectomy, on lipid profile and compare the results in both groups.
The study is aimed to evaluate the effect of two types of bariatric surgery; mini-gastric bypass and sleeve gastrectomy, on lipid profile and compare the results in both groups.
This study was carried out on sixty morbidly obese persons divided into 2 groups: (Group1): included 30 patients underwent mini-gastric bypass, (Group2): included 30 patients underwent sleeve gastrectomy.
The main results of the study revealed that:
Preoperative:
Demographic data analysis between the two groups shows that age of patients in (mini gastric bypass) group was significantly higher than age of (sleeve gastrectomy) group (39.47 + 11.13 years vs 33.67 + 11.02 years respectively) (p value =0.05).
No statistically significant difference was found between the two groups regarding sex distribution.
Baseline preoperative anthropometric measures showed that no statistically significant difference between the two groups.
Baseline pre-operative lipid profile measures showed no statistically significant difference between the two groups regarding Total cholesterol and HDL levels while there was a significant difference in LDL and triglycerides levels.
It shows that LDL level of patients in (sleeve gastrectomy) group was significantly higher than LDL level of (mini gastric bypass) group (179.33 + 28.98 mg/dl vs 157.86 + 31.66 mg/dl respectively) (p value <0.05) while triglycerides level of patients in (mini gastric bypass) group was significantly higher than triglycerides level of (sleeve gastrectomy) group (222.50 + 56.44 mg/dl vs 188.59 + 28.92 mg/dl respectively) (p value <0.05).
Three months post-operative:
Three months post-operative anthropometric measures show that post-operative weight and BMI were significantly higher in mini gastric bypass group than sleeve gastrectomy group (108 + 14.2 Kg vs 100.98 + 12.27 Kg and 42.85 + 4.90 Kg/m2 vs 38.84 + 4.39 Kg/m2 respectively) (p value <0.05).
Three months post-operative lipid profile in both groups is significantly improved compared to pre-operative one still there was significant different between the two groups regarding the amount of change.
Comparing the two groups regarding amount of change in Total cholesterol. It shows that there was a statistically significant difference between pre and post-operative Total cholesterol in both groups (p value <0.05), there was no statistically significant difference between two groups regarding mean Total cholesterol (p value > 0.05) and there was no statistically significant difference between two groups regarding amount of change in Total cholesterol (p value >0.05).
Comparing the two groups regarding amount of change in HDL. It shows that there was a statistically significant difference between pre and post-operative HDL in both groups (p value <0.05), there was no statistically significant difference between two groups regarding mean HDL (p value > 0.05) and there was a statistically significant difference between two groups regarding amount of change in HDL ( p value <0.05).
Comparing the two groups regarding amount of change in LDL. It shows that there was a statistically significant difference between pre and post-operative LDL in both groups (p value <0.05), there was a statistically significant difference between two groups regarding mean LDL (p value < 0.05) and there was a statistically significant difference between two groups regarding amount of change in LDL (p value <0.05).
Comparing the two groups regarding amount of change in Triglycerides. It shows that there was a statistically significant difference between pre and post-operative triglycerides in both groups (p value <0.05), there was a statistically significant difference between two groups regarding mean triglycerides (p value < 0.05) and there was a statistically significant difference between two groups regarding amount of change in triglycerides (p value <0.05).
Based on our results, from cardioprotective point of view, we recommend SG could be the preferred operation for patients with dyslipidemia.
The reason is that in spite that the decrease of LDL cholesterol and triglycerides being similar to MGB, still a higher increase of HDL being documented.
Both studied laparoscopic techniques; LSG and MGB were safe and effective, still short term results showed that SG could be the preferred operation in patients with dyslipidemia.
The reason is that in spite that the decrease of LDL cholesterol and triglycerides being similar to MGB, a higher increase of HDL being documented.
Further studies on large geographical scale and on larger sample size to emphasize our conclusion.
More patients, longer follow-up, and multicenter experience are all necessary to accurately figure out the long-term effect of sleeve gastrectomy and mini-gastric bypass, on lipid profile.